NPIMap

Individual provider Active NPI

Stacy Kristin Kotalik, CNP

  • Family Nurse Practitioner
  • Yankton, SD
National Provider Identifier
1164967774
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP001147 Issued in SD
Practice address
409 Summit St Ste 2500
Yankton, SD 57078-3739
Phone
(605) 655-1710
Fax
(605) 655-1711
NPI assigned
Jan 5, 2017
Last updated
Nov 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CP001147 SD Primary

Addresses

Primary practice location

409 Summit St Ste 2500
Yankton, SD 57078-3739

Mailing address

1104 W 8TH St
Yankton, SD 57078-3306
Phone (605) 665-7841

Other practice location 1

1104 W 8th St
Yankton, SD 57078-3306
Phone (605) 665-7841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170405001066 SD Practitioner - Nurse Practitioner 8325324312 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Heart Health ServicesGroup PAC ID 6103729066, 151 clinicians

Practice addresses (Care Compare)

1000 W 4TH St
Suite 8
Yankton, SD 57078-3700

409 Summit St
Suite 2500
Yankton, SD 57078-3739
Phone (605) 655-1710

501 Summit St
Yankton, SD 57078-3855
Phone (605) 668-8795

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CP001147SDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health Services CurrentSince May 29, 2018 Accepting new patients
Sacred Heart Health Services CurrentSince May 29, 2018 Accepting new patients
Sacred Heart Health Services Current Accepting new patients
Sacred Heart Health Services PastSince Dec 16, 2020 Accepting new patients

Locations

1104 W 8th St
Yankton, SD 57078
Phone (605) 665-7841

409 Summit St
Ste 2500
Yankton, SD 57078
Phone (605) 655-1710

501 Summit St
Yankton, SD 57078
Phone (605) 655-1201

Interoperability endpoints

  • Direct secure messaging: stacy.kotalik@avera.sdhealthlink.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 31

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1164967774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 W 8TH ST",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570783306",
            "telephone_number": "605-665-7841",
            "fax_number": "605-665-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 SUMMIT ST STE 2500",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570783739",
            "telephone_number": "605-655-1710",
            "fax_number": "605-655-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1104 W 8th St",
            "address_purpose": "LOCATION",
            "city": "Yankton",
            "state": "SD",
            "postal_code": "570783306",
            "country_code": "US",
            "telephone_number": "605-665-7841",
            "fax_number": "605-665-0546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTALIK",
        "first_name": "STACY",
        "middle_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP001147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yankton, SD

Sources for this page

Verify at the official NPI Registry.